Thursday, August 17, 2017

Every therapist has new tricks

Max's occupational therapist of more than five years left us last spring. She was pregnant and planning to take a break, and also feeling like she didn't have much more to offer Max. In the past year, she'd gotten into the MNRI method (Masgutova Neurosensorimotor Reflex Integration). She showed us how to do the exercises, and I bought the handbook; some are great for relaxing Max's muscles. The ultimate goal is to integrate certain reflexes that inhibit movement. She recommended we do a week-long MNRI conference when it came to our area. I was not convinced six hours of treatment a day for five days would have a lasting impact on Max, and neither was our neurologist. Also: It cost $6750.

I knew another OT would have new tactics to try. The challenge was finding one who'd come to our home, because I work and can't hustle Max to therapies during weekdays. I put out a lot of feelers and got lucky—I found two new ones, and booked them both.

The first, Liz, came over this week. A guy was in the basement fixing our furnace, which had leaked over the weekend and flooded part of our basement. As Liz stood in our kitchen he came upstairs and said, "I hate to tell you but your washing machine flooded." Sure enough, there was water all over the laundry area. Yep, two floods in two days, unrelated. So I was distracted while she was there, and not paying attention to what she and Max were up to on the deck.

When she'd met Max weeks ago, she asked what I thought we should focus on and I told her life skills. Max's fingers often don't do what he'd like them to do, and he needs help with everything from pulling up his pants to brushing his teeth.

"You want to do that stuff, right, Max?" I asked.

He did not seem all that enthusiastic. He sometimes resists doing things himself because they are hard, and because he knows Dave and I will step in.

At the end of the session, Liz and Max walked in as I was on the hold for getting a washing machine repair scheduled.

"Max, do you think your mom can guess what we spoke about?"

My first guess was Las Vegas, Max's December joy trip with Dave and his grandpa.

Nope.

Going to high school?

Nope.

Firefighters?

Ding ding ding!

"Max, tell your mom what we spoke about," she said.

Max said a word I didn't understand. Liz presented a red piece of construction paper with a list, and I scanned it. Ah. He was saying "strong." As in, he wanted to get stronger so he could be a firefighter.

The list is titled "Things Fireman Max wants to do by himself." They include: Getting dressed, from his undies on up; brushing teeth; cooking; using his right hand more; and getting stronger so he could climb a ladder as a firefighter.

"This sounds great!" I said. "You need to do all of these things to be a firefighter. Because you want to live in the station, right?"

"Yes," he said.

Max's old therapist had gotten him to move around by reenacting fire scenarios. I loved how Liz was tapping into his firefighter aspirations to give him intrinsic motivation to work on life skills. As I know well, nothing happens with Max until he's ready to make it happen—and he wants to.

My experience is that it is good to change therapists (though I've never done it without being forced :-) At school Luke was having problems with doing too much touching of others, some inappropriate, most not. At school last year he got a new OT. When she and I had our first conversation we talked about this. Her very first observation was that they were doing a brushing protocol at school. Therefor it was OK for the therapists/paras/teachers to touch Luke, but it wasn't OK for him to touch them (Duh!). It took some fresh eyes. School has only been in session for 1 1/2 weeks now, so I don't know how things such as this are going at the high school, where there are a whole bunch of fresh eyes.

It's so amazing how much perspective a new therapist can bring, in so many ways. That said, we've had the same speech therapist since Max was a tot and we are really grateful. Max works well with her and she's really smart, devoted and on top of techniques. I wonder about how things are going to go in high school, too. Ours has less of a focus on therapy than his elementary/middle school.